FUTURE OF HYPERTENSION

- Anirudhya J

Introduction• Arterial hypertension is a controllable disease that

affects as much as 30-45 % of general population.

• The prevalence of treatment resistant hypertension has been reported to be from 10-15 %

• Uncontrolled hypertension was found in 35.9 % of patients of which 2.2 % were resistant.

Only 6 novel molecules have been approved by the FDA in this millenium :

• Valsartan (2001)• Eplerenone (2002) – Aldosterone receptor

antagonist • Olmesartan (2003)• Aliskiren (2007) – Renin inhibitor – Lowers BP ,

reduces albuminuria, limits LVH.• Clevidipine (2008)• Azilsartan medoxomil (2011)

Future paradigm in management Telemonitoring of BP

Mobile health technology (mHealth) offers opprtunities to support self-management behaviour, thereby actively engaging patients in their care and reduce the number of office visits.

Interventional therapies• May be considered in patients with resistant

hypertension.

1) Baroreceptor activation therapy: - Carotid baroreceptors play a key role in BP regulation and impairment in their function has been associated with development and maintenance of hypertension.

Continued…- Chronic electrical stimulation of carotid sinus nerves via implantable devices has shown significant reduction in BP.

- The Rheos Baroreflex activation therapy system was used earlier.

- A modified version of this – Barostim neo system is a second generation device for baroreflex activation therapy.

- Adverse effects : Infection, Nerve damage (Tongue paresis), Pain in the glossopharyngeal nerve area, Shifting of the implanted generator that required further surgery.

2 ) Renal denervation :

- Renal sympathetic nerves contribute to both development and maintenance of hypertension.

- Catheter based RDN has emerged as a potential treatment modality for resistant hypertension.

- The procedure involves catheter based ablation of both afferent and efferent nerves in the renal arteries.

Continued…

• The most futuristic of the RDN systems are non-invasive, delivering externally focused ultrasound energy to the renal nerves using Doppler-based ultrasound image guidance to track and correct for renal artery motion during treatment.

3) ROX coupler :

- Another device based intervention for resistant hypertension.

- The Coupler is surgically implanted between a vein and an artery in the upper thigh.

- It acts on arterial compliance and vascular resistance to reduce BP.

Chronotherapy• A 69 % prevalence of nocturnal non-dipping has

been observed in patients with resistant hypertension.

• Non-dipping is partly related to the absence of homogeneous 24 hour therapeutic coverage in patients treated with single morning doses.

• A novel therapeutic strategy based on chronotherapy can be adopted which involves a unique time of the

day for conventional drug administration.

Endothelin a receptor antagonists• Endothelin is a potent vasoconstrictor and growth

factor and is commonly associated with renal disease.

• Selective ET receptor blockade has been shown to have therapeutic potential in HTN, atherosclerosis, HF, pulmonary disease and renal end organ damage.

Vaccines for hypertension

• Researchers are working on a vaccine against the

renin-angiotensin system to control hypertension.

Thank you